Commonwealth of Massachusetts
MassHealth
Provider Manual Series
Home- and Community-Based
Services Manual
Subchapter Number and Title
Table of Contents
Page
iv
Transmittal Letter
HCBS-1
Date
04/01/13
4. Program Regulations
630.401:
Introduction....................................................................
....................................................... 4-1
630.402: Definitions
................................................................................
............................................. 4-1
630.403: Eligible
Members.........................................................................
.......................................... 4-8
630.404: Provider
Eligibility.....................................................................
............................................ 4-9
630.405: Home- and Community-Based Waiver Coverage
Types..................................................... 4-14
630.406: Home- and Community-Based Waiver Conditions for
Payment......................................... 4-16
630.407: Home- and Community-Based Waiver Coverage Requirements
........................................ 4-16
630.408: Nonpayable
Services........................................................................
.................................... 4-17
630.409:
Service Plan and Notice of Approval or Denial of Home- and Community-Based
Waiver Services
................................................................................
............................ 4-18
630.410: Adult
Companion.......................................................................
.......................................... 4-19
630.411: Assisted Living
Services........................................................................
.............................. 4-19
630.412: Chore Services
................................................................................
..................................... 4-19
630.413: Community-Based Substance Abuse
Treatment.................................................................. 4-20
630.414: Community Family Training and Residential Family
Training........................................... 4-20
630.415: Day Services
................................................................................
........................................ 4-20
630.416: Home Accessibility
Adaptations.....................................................................
..................... 4-21
630.417:
Homemaker.......................................................................
.................................................. 4-21
630.418: Home Health Aide
................................................................................
............................... 4-21
630.419: Independent Living
Supports........................................................................
....................... 4-22
630.420: Individual Support and Community
Habilitation................................................................. 4-
22
630.421: Peer
Support.........................................................................
............................................... 4-22
630.422: Personal Care
Services........................................................................
................................. 4-23
630.423: Prevocational Services
................................................................................
......................... 4-23
630.424: Residential Habilitation
................................................................................
....................... 4-23
630.425: Respite
................................................................................
............................................... 4-24
630.426: Shared Home Supports
................................................................................
........................ 4-24
630.427: Shared Living – 24 Hour Supports
................................................................................
...... 4-25
630.428: Skilled Nursing
................................................................................
.................................... 4-25
630.429: Specialized Medical
Equipment.......................................................................
.................... 4-26
630.430: Supported Employment
................................................................................
....................... 4-26
630.431: Supportive Home Care
Aide............................................................................
.....................4-27
630.432: Occupational Therapy, Physical Therapy, and Speech
Therapy...........................................4-27
630.433: Transitional Assistance
................................................................................
........................4-28
630.434:
Transportation..................................................................
....................................................4-29
630.435: Vehicle Modification
................................................................................
........................... 4-30
630.436: Location Requirements for Home- and Community-Based Waiver
Providers.................... 4-30
630:437:
Personnel Requirements and Responsibilities of Home- and Community-Based
Waiver Providers
................................................................................
....................................... 4-31
630.438: Withdrawal by a Home- and Community-Based Waiver Provider from
MassHealth......... 4-33
630.439: Recordkeeping Requirements
................................................................................
.............. 4-34
Commonwealth of Massachusetts
MassHealth
Provider Manual Series
Subchapter Number and Title
Preface
Page
vii
Home- and Community-Based
Services Manual
Transmittal Letter
HCBS-1
Date
04/01/13
The regulations and instructions governing provider participation in MassHealth
are published in the
Provider Manual Series. MassHealth publishes a separate manual for each provider
type.
Manuals in the series contain administrative regulations, billing regulations,
program regulations, service
codes, administrative and billing instructions, and general information.
MassHealth regulations are
incorporated into the Code of Massachusetts Regulations (CMR), a collection of
regulations promulgated by
state agencies within the Commonwealth and by the Secretary of State. MassHealth
regulations are assigned
Title 130 of the Code. Pages that contain regulatory material have a CMR chapter
number in the banner
beneath the subchapter number and title.
Administrative regulations and billing regulations apply to all providers and
are contained in 130 CMR
Chapter 450.000. These regulations are reproduced as Subchapters 1, 2, and 3 in
this and all other manuals.
Program regulations cover matters that apply specifically to the type of
provider for which the manual was
prepared. For home- and community-based waiver service providers, those matters
are covered in 130 CMR
Chapter 630.000, reproduced as Subchapter 4 in the Home- and Community-Based
Services Manual.
Revisions and additions to the manual are made as needed by means of transmittal
letters, which furnish
instructions for substituting, adding, or removing pages. Some transmittal
letters will be directed to all
providers; others will be addressed to providers in specific provider types. In
this way, a provider will receive
all those transmittal letters that affect its manual, but no others.
The Provider Manual Series is intended for the convenience of providers. Neither
this nor any other manual
can or should contain every federal and state law and regulation that might
affect a provider's participation in
MassHealth. The provider manuals represent instead MassHealth’s effort to give
each provider a single
convenient source for the essential information providers need in their routine
interaction with MassHealth
and its members.
Commonwealth of Massachusetts
MassHealth
Provider Manual Series
Subchapter Number and Title
4. Program Regulations
(130 CMR 630.000)
Page
4-1
Home- and Community-Based
Services Manual
Transmittal Letter
HCBS-1
Date
04/01/13
630.401: Introduction
130 CMR 630.000 governs the provision of services under the MassHealth Home and
Community-Based Services (HCBS) waivers, which include the Acquired Brain Injury
Home-
and Community-Based Services waivers (ABI waivers). All providers of services
under the
HCBS waivers must comply with MassHealth regulations set forth in 130 CMR
630.000 and
450.000.
630.402: Definitions
The following terms used in 130 CMR 630.000 have the meanings given in 130 CMR
630.402 unless the context clearly requires a different meaning.
Acquired Brain Injury (ABI) – all forms of brain injury that occur after age 22,
including without
limitation brain injuries caused by external force, but not including
Alzheimer’s disease and
similar neurodegenerative diseases of which the primary manifestation is
dementia.
Acquired Brain Injury Home- and Community-Based Service Waiver (ABI Waiver) –
Two
Massachusetts home- and community-based services waivers for persons with
acquired brain
injury are approved by the Centers for Medicare & Medicaid Services (CMS) under
Section
1915(c) of the Social Security Act. The two separate Acquired Brain Injury
Waivers, each with
different covered services and eligibility requirements are: the Acquired Brain
Injury with
Residential Habilitation (ABI-RH) Waiver and the Acquired Brain Injury Non-
Residential
Habilitation (ABI-N) Waiver.
Activities of Daily Living (ADL) – certain basic tasks required for daily
living, including the
ability to bathe, dress/undress, eat, toilet, transfer in and out of bed or
chair, get around inside the
home, and manage incontinence.
Adult Companion Service – nonmedical care, supervision, and socialization
provided to a
participant. Companions may assist or supervise the participant with such light
household tasks
as meal preparation, laundry, and shopping.
Assisted Living Services – services consists of personal care and supportive
services
(homemaker, chore, personal care services, meal preparation) that are furnished
to participants
who reside in a Money Follows the Person (MFP) qualified assisted living
residence (ALR) that
includes 24-hour on-site response capability to meet scheduled or unpredictable
resident needs
and to provide supervision, safety and security. Services may also include
social and recreational
programs, and medication assistance (consistent with ALR certification and to
the extent
permitted under State law). Nursing and skilled therapy services are incidental
rather than
integral to the provision of Assisted Living Services. Intermittent skilled
nursing services and
therapy services may be provided to the extent allowed by applicable
regulations.
Commonwealth of Massachusetts
MassHealth
Provider Manual Series
Subchapter Number and Title
4. Program Regulations
(130 CMR 630.000)
Page
4-2
Home- and Community-Based
Services Manual
Transmittal Letter
HCBS-1
Date
04/01/13
Behavioral Health Diversionary Services – services that are provided, as
necessary and
appropriate, to all Participants enrolled in the MFP waivers through the state’s
MassHealth
managed behavioral health plan. Under the managed behavioral health plan,
participants have
access to mental health and substance use disorder services that are clinically
appropriate
alternatives to behavioral health inpatient services, or support a participant
returning to the
community following a 24-hour acute placement; or provide intensive support to
maintain
functioning in the community.
Chore – an unusual or infrequent household maintenance task that is needed to
maintain the
participant’s home in a clean, sanitary, and safe environment. This service
includes heavy
household chores such as washing floors, windows, and walls; tacking down loose
rugs and tiles;
and moving heavy items of furniture in order to provide safe access and egress.
Community-Based Substance Abuse Treatment – individually designed strategies and
approaches
provided via 24-hour support and supervision in a residential rehabilitation
substance abuse
treatment and education program for adults, that promote independence and
integration to
decrease the participant’s substance and/or alcohol abuse behaviors that
interfere with his or her
ability to remain in the community.
Community Family Training – a service designed to provide training and
instruction about the
treatment regimes, behavior plans, and the use of specialized equipment that
support a participant
in the community. Community family training may also include training in family
leadership,
support of self-advocacy and independence for the family member. The service
enhances the
skills of the family to assist the waiver participant to function in the
community and at home.
Coverage Type – a scope of services that are available to MassHealth members who
meet
specific eligibility criteria.
Day Services – a structured, site-based, group program for participants that
offers assistance with
the acquisition, retention, or improvement in self-help, socialization, and
adaptive skills, and that
takes place in a nonresidential setting separate from the participant’s private
residence or other
residential living arrangement. Services often include assistance to learn
activities of daily living
and functional skills; language and communication training; compensatory,
cognitive and other
strategies; interpersonal skills; prevocational skills; and recreational and
socialization skills.
Family Member – a spouse or any legally responsible relative of the participant.
Fiscal Intermediary (FI) – an entity under contract with EOHHS to perform
employer-required
tasks and related administrative tasks as described in 130 CMR 422.400.
Home Accessibility Adaptations – physical modifications to the participant’s
home that are
necessary to ensure the health, welfare, and safety of the participant or that
enable the participant
to function with greater independence in the home.
Commonwealth of Massachusetts
MassHealth
Provider Manual Series
Subchapter Number and Title
4. Program Regulations
(130 CMR 630.000)
Page
4-3
Home- and Community-Based
Services Manual
Transmittal Letter
HCBS-1
Date
04/01/13
Home and Community-Based Services (HCBS) Waiver – A federally approved program
operated
under Section 1915(c) of the Social Security Act that authorizes the U.S.
Secretary of Health and
Human Services to grant waivers of certain Medicaid statutory requirements so
that a state may
furnish home and community based services to certain Medicaid beneficiaries who
need a level
of care that is provided in a hospital, nursing facility, or Intermediate Care
Facility for the
Mentally Retarded (ICF/MR). For the purpose of this Regulation, Home and
Community-Based
Service Waiver refers to the two ABI waivers and the two MFP waivers.
Homemaker – a person who performs light housekeeping duties (for example,
cooking, cleaning,
laundry, and shopping) for the purpose of maintaining a household.
Home Health Aide – a person who performs certain personal care and other health-
related
services as described in 130 CMR 403.400.
Independent Living Supports – a service that ensures 24 hour seven days a week
access to
supportive services for participants who have intermittent, scheduled and
unscheduled needs for
various forms of assistance, but who do not require 24-hour supervision. It
provides participants
with services and supports in a variety of activities such as: ADLs and
instrumental activities of
daily living (IADLs), support and companionship, emotional support and
socialization. This
service is provided by a site-based provider, and is available to participants
who choose to reside
in locations where a critical mass of individuals reside who require such
support and where
providers of such supports are available.
Individual Support and Community Habilitation – regular or intermittent services
designed to
develop, maintain, and/or maximize the participant’s independent functioning in
self-care,
physical and emotional growth, socialization, communication, and vocational
skills, to achieve
objectives of improved health and welfare and to the support the ability of the
participant to
establish and maintain a residence and live in the community.
Instrumental Activities of Daily Living (IADL) – certain basic environmental
tasks required for
daily living, including the ability to prepare meals, do housework, laundry, and
shopping, get
around outside, use transportation, manage money, and use the telephone.
Legally Responsible Individual – any person who has a duty under state law to
care for another
person and includes a legal guardian or a spouse of a participant.
Commonwealth of Massachusetts
MassHealth
Provider Manual Series
Subchapter Number and Title
4. Program Regulations
(130 CMR 630.000)
Page
4-4
Home- and Community-Based
Services Manual
Transmittal Letter
HCBS-1
Date
04/01/13
Massachusetts Rehabilitation Commission (MRC) – the state agency within the
Executive Office
of Health and Human Services that is organized pursuant to M.G.L. c. 6 §§ 74-84,
to provide
comprehensive services to individuals with disabilities, which maximize their
quality of life and
economic self-sufficiency. MRC accomplishes its work through multiple programs
in its
Community Living Division, the Disability Determination Service Division and the
Vocational
Rehabilitation Division.
Money Follows the Person Demonstration (MFP Demonstration) – a MassHealth
demonstration
program authorized through 2016 pursuant to a federal grant received by EOHHS
that seeks to
assist eligible Members residing in institutional long term care settings to
transition to
community-based settings where they can receive home and community-based
services.
Money Follows the Person Waivers (MFP Waivers) – two Massachusetts Home and
Community-
Based Services Waivers for persons participating in the MFP Demonstration and
approved by the
CMS under Section 1915(c) of the Social Security Act. Massachusetts operates two
separate MFP
Waivers – the Money Follows the Person Residential Supports (MFP-RS) waiver and
the Money
Follows the Person Community Living (MFP-CL) waiver – each with different
covered services
and eligibility requirements.
Occupational Therapist – a person who is licensed by the Massachusetts Division
of Registration
in Allied Health Professions and registered by the American Occupational Therapy
Association
(AOTA) or is a graduate of a program in occupational therapy approved by the
Committee on
Allied Health Education and Accreditation of the American Medical Association
and engaged in
the supplemental clinical experience required before registration by AOTA.
Occupational Therapy – therapy services, including diagnostic evaluation and
therapeutic
intervention, designed to improve, develop, correct, rehabilitate, or prevent
the worsening of
functions that affect the activities of daily living that have been lost,
impaired, or reduced as a
result of acute or chronic medical conditions, congenital anomalies, or
injuries. Occupational
therapy programs are designed to improve quality of life by recovering
competence and
preventing further injury or disability, and to improve the individual’s ability
to perform tasks
required for independent functioning, so that the individual can engage in
activities of daily
living.
Participant – a MassHealth member determined by the MassHealth agency to be
eligible for
enrollment in one of the HCBS waivers, who chooses to receive HCBS waiver
services, and for
whom a service plan has been developed that includes one or more HCBS waiver
services.
Commonwealth of Massachusetts
MassHealth
Provider Manual Series
Subchapter Number and Title
4. Program Regulations
(130 CMR 630.000)
Page
4-5
Home- and Community-Based
Services Manual
Transmittal Letter
HCBS-1
Date
04/01/13
Peer Support – on-going services and supports designed to assist participants to
acquire, maintain
or improve the skills necessary to live in a community setting. This service
provides supports
necessary for the participant to develop the skills that enable them to become
more independent,
integrated into, and productive in their communities. The service enables the
participant to retain
or improve skills related to personal finance, health, shopping, use of
community resources,
community safety, and other adaptive skills needed to live in the community.
Personal Care – services provided to a participant, which may include physical
assistance,
supervision or cuing of participants, for the purpose of assisting the
participant to accomplish
activities of daily living(ADLs), including, but not limited to, eating,
toileting, dressing, bathing,
transferring, and ambulation.
Physical Therapist – a person licensed by the Massachusetts Division of
Registration in Allied
Health Professions to provide physical therapy.
Physical Therapy – therapy services, including diagnostic evaluation and
therapeutic
intervention, designed to improve, develop, correct, rehabilitate, or prevent
the worsening of
physical functions that have been lost, impaired, or reduced as a result of
acute or chronic
medical conditions, congenital anomalies, or injuries. Physical therapy
emphasizes a form of
rehabilitation focused on treatment of dysfunctions involving neuromuscular,
musculoskeletal,
cardiovascular/pulmonary, or integumentary systems through the use of
therapeutic interventions
to optimize functioning levels.
Prevocational Services – a service that consists of a range of learning and
experiential type
activities that prepare a participant for paid or unpaid employment in an
integrated, community
setting. Services are not job-task oriented but instead, aimed at a generalized
result (e.g. attention
span, motor skills). The service may include teaching such concepts as
attendance, task
completion, problem solving and safety as well social skills training, improving
attention span,
and developing or improving motor skills. Basic skill-building activities are
expected to
specifically involve strategies to enhance a participant’s employability in
integrated, community
settings.
Provider Agreement – the contract between the MassHealth agency and a person or
organization
under which the provider agrees to furnish services to MassHealth members in
compliance with
state and federal Title XIX requirements. Federal regulations concerning
provider agreements are
located in 42 CFR § 431.107.
Residential Family Training – a service designed to provide training and
instruction about
treatment regimes, behavior plans, and the use of specialized equipment that
supports a
participant in the community. Residential family training may also include
training in family
leadership, support of self-advocacy, and independence for the family member.
The service
enhances the skill of the family to assist the waiver participant to function in
the community and
at home when the waiver participant visits the family home.
Commonwealth of Massachusetts
MassHealth
Provider Manual Series
Subchapter Number and Title
4. Program Regulations
(130 CMR 630.000)
Page
4-6
Home- and Community-Based
Services Manual
Transmittal Letter
HCBS-1
Date
04/01/13
Residential Habilitation – ongoing services and supports provided to a
participant in a provider-
operated residential setting that are designed to assist participants in
acquiring, maintaining, or
improving the skills necessary to live in a community setting. Residential
habilitation provides
participants with daily staff intervention including care, supervision, and
skills training in
activities of daily living, home management, and community integration in a
qualified residential
setting with 24-hour staffing. This service may include the provision of medical
and health-care
services that are integral to meeting the daily needs of participants.
Respite Services – services provided to individuals unable to care for
themselves; furnished on a
short-term basis because of the absence or need for relief of unpaid caregivers.
Room and Board – the term “room” means shelter-type expenses, including all
property-related
costs, such as rental or purchase of real estate, maintenance, utilities, and
related administrative
services. The term “board” means up to three meals a day or any other full
nutritional regimen.
Self-Directed Services – a model of service delivery in which a waiver
participant has decision
making authority over certain aspects of the delivery of their care.
Service Plan – a written document that specifies the waiver and other services
(regardless of
funding source), along with any informal supports that are furnished to meet the
needs of and to
assist a participant in remaining in the community. The service plan is also
known as the
individual service plan or waiver plan of care.
Shared Home Supports - an individually tailored supportive service that assists
with the
acquisition, retention, or improvement in skills related to living in the
community. A participant
is matched with a shared Home supports caregiver. This arrangement is overseen
by a residential
support agency. Shared home supports do not include 24-hour care. Shared home
supports
include such supports as: adaptive skill development, assistance with ADLs and
IADLs, adult
educational supports, social and leisure skill development, and supervision.
Shared Living-24 Hour Supports – a residential service that matches a
participant with a shared
living caregiver. This arrangement is overseen by a residential support agency.
Shared living is an
individually tailored 24 hour/7 day per week, supportive service available to a
participant who
needs daily structure and supervision. Shared living includes supportive
services that assist with
the acquisition, retention, or improvement of skills related to living in the
community. This
includes such supports as: adaptive skill development, assistance with ADLs and
IADLs, adult
educational supports, social and leisure skill development, protective oversight
and supervision.
Commonwealth of Massachusetts
MassHealth
Provider Manual Series
Subchapter Number and Title
4. Program Regulations
(130 CMR 630.000)
Page
4-7
Home- and Community-Based
Services Manual
Transmittal Letter
HCBS-1
Date
04/01/13
Skilled Nursing Services - the assessment, planning, provision, and evaluation
of goal-oriented
nursing care that requires specialized knowledge and skills acquired under the
established
curriculum of a school of nursing approved by a board of registration in
nursing. Such services
include only those services that require the skills of a nurse. Skilled nursing
services are
provided by a person licensed as a registered nurse or a licensed practical
nurse by a state’s board
of registration in nursing.
Specialized Medical Equipment and Supplies – devices, controls, or appliances to
increase
abilities in activities of daily living, or to control or communicate with the
environment.
Speech/Language Therapist – a person who is licensed by the Massachusetts
Division of
Registration in Speech-Language Pathology and Audiology and has either a
Certificate of
Clinical Competence from the American Speech-Language-Hearing Association (ASHA)
or a
statement from ASHA of certification equivalency.
Speech/Language Therapy – therapy services, including diagnostic evaluation and
therapeutic
intervention, that are designed to improve, develop, correct, rehabilitate, or
prevent the worsening
of speech/language communication and swallowing disorders that have been lost,
impaired, or
reduced as a result of acute or chronic medical conditions, congenital
anomalies, or injuries.
Speech and language disorders are those that affect articulation of speech,
sounds, fluency, voice,
swallowing (regardless of presence of a communication disability), and those
that impair
comprehension, spoken, written, or other symbol systems used for communication.
Supported Employment – regularly scheduled services that enable participants,
through training
and support, to work in integrated work settings in which individuals are
working toward
compensated work, consistent with the strengths, resources, priorities,
concerns, abilities,
capabilities, interests, and informed choice of the individuals.
Supportive Home Care Aide – services provided to participants with
Alzheimer/dementia or
behavioral health needs to assist with ADLs and IADLs. These services include
personal care,
shopping, menu planning, meal preparation including special diets, laundry,
light housekeeping,
escort, and socialization /emotional support.
Transitional Assistance – nonrecurring residential set-up expenses for
participants who are
transitioning from a nursing facility or hospital to a community living
arrangement where the
participant is directly responsible for his or her own set-up expenses.
Allowable expenses are
those that are necessary to enable a person to establish a basic household and
do not constitute
room and board.
Commonwealth of Massachusetts
MassHealth
Provider Manual Series
Subchapter Number and Title
4. Program Regulations
(130 CMR 630.000)
Page
4-8
Home- and Community-Based
Services Manual
Transmittal Letter
HCBS-1
Date
04/01/13
Transportation Service – conveyance of participants by vehicle, from their
residence to and from
the site of HCBS waiver services and other community services, activities, and
resources,
including physical assistance to participants while entering and exiting the
vehicle.
Vehicle Modification – necessary adaptations or alterations to an automobile or
van that is the
waiver participant’s primary means of transportation and that is not owned or
leased by an entity
providing services to the participant. Vehicle modifications are necessary when
they are required
to accommodate special needs of the participant. Examples of vehicle
modifications include: van
lift, tie downs, ramp, specialized seating equipment and seating/safety
restraint.
Visit – a face-to-face personal contact with the participant for the purpose of
providing an HCBS
waiver service.
Waiver Provider – a qualified individual or organization that meets the
requirements of 130 CMR
630.000, provides waiver services to participants, and has signed a provider
agreement with the
MassHealth agency.
Waiver Services – home- and community-based services that are covered in
accordance with the
requirements of 130 CMR 630.000 for participants enrolled under an ABI waiver or
MFP waiver.
630.403: Eligible Members
(A) MassHealth pays for services under an HCBS waiver only when provided to
eligible
MassHealth members who are enrolled as participants in the HCBS waiver, in
accordance with
130 CMR 519.007(G) and (H), subject to the restrictions and limitations
described in 130 CMR
630.000 and 450.000. 130 CMR 630.405 specifically states, for each HCBSwaiver,
which HCBS
waiver services are covered and which HCBS waiver participants are eligible to
receive those
services.
(B) For information on verifying member eligibility and coverage type, see 130
CMR 450.107.
Commonwealth of Massachusetts
MassHealth
Provider Manual Series
Subchapter Number and Title
4. Program Regulations
(130 CMR 630.000)
Page
4-9
Home- and Community-Based
Services Manual
Transmittal Letter
HCBS-1
Date
04/01/13
630.404: Provider Eligibility
(A) Requirements for Participation. An individual or organization seeking to
participate as a
provider of services under an HCBS waiver must
(1) be duly authorized to conduct a business in Massachusetts that delivers
health or human
services to elderly or disabled adult populations;
(2) comply with all standards, requirements, policies, and procedures
established by the
MRC for the provision of services under an HCBS waiver;
(3) meet the applicable HCBS waiver service provider application qualifications;
(4) comply with all standards, requirements, policies, and procedures
established by the
MassHealth agency for the participation of providers in MassHealth, including
all provider
participation requirements described in 130 CMR 630.000 and 450.000;
(5) obtain, as required, a MassHealth provider number; and
(6) accept MassHealth payment, or MRC payment where applicable, as payment in
full for all
services provided under an HCBS waiver.
(B) Required Documentation. All required MassHealth application documentation
will be
specified by the MassHealth agency. In order to participate as an HCBS waiver
provider, an
applicant must submit all required documentation, and the MassHealth agency or
its designee
must approve it.
(C) Periodic Inspections. The MassHealth agency or its designee may conduct
periodic
inspections of HCBS waiver providers to ensure compliance with all provider
participation
requirements described in 130 CMR 630.000 and 450.000. An HCBS waiver provider
must
cooperate with any inspection and furnish any requested records.
(D) HCBS Waiver Provider Eligibility Requirements by Service Type.
(1) Adult Companion. In order to participate as a provider of adult companion
services
under an HCBS waiver, a provider must be a health or human service organization
or an
individual with experience providing nonmedical care, supervision, and
socialization for
persons with disabilities in accordance with all standards, requirements,
policies, and
procedures established by the MRC for the provision of such services.
(2) Assisted Living Services. In order to participate as a provider of assisted
living services
under a HCBS waiver, a provider must be certified as an assisted living
residence by the
Executive Office of Elder Affairs in accordance with 651 CMR 12.00 and meet the
MFP
waiver qualified residence requirements.
(3) Chore Service. In order to participate as a provider of chore services under
an HCBS
waiver, a provider must be a health or human service organization or an
individual with
experience providing services needed to maintain the home in a clean, sanitary,
and safe
condition, in accordance with all standards, requirements, policies, and
procedures
established by the MRC for the provision of such services.
Commonwealth of Massachusetts
MassHealth
Provider Manual Series
Subchapter Number and Title
4. Program Regulations
(130 CMR 630.000)
Page
4-10
Home- and Community-Based
Services Manual
Transmittal Letter
HCBS-1
Date
04/01/13
(4) Community-Based Substance Abuse Treatment. In order to participate as a
provider of
community-based substance abuse treatment under an HCBS waiver, a provider must
be
licensed as a residential rehabilitation substance abuse treatment and education
program for
adults that meets the requirements of the Massachusetts Department of Public
Health in
accordance with 105 CMR 164.400 through 164.424.
Community-based substance abuse treatment may be provided only by private
organizations
that operate freestanding residential rehabilitation substance abuse treatment
and education
programs for adults. These services may not be provided in any unit that is
licensed as a
hospital, nursing facility, or similar medical facility.
(5) Day Services. In order to participate as a provider of day services under an
HCBS
waiver, a provider must be a health or human service organization with
experience providing
day services to persons with disabilities in accordance with all standards,
requirements,
policies, and procedures established by the MRC for the provision of day
services to persons
with disabilities. Day services must be provided at a provider-operated site in
the community
and not in a participant's residence. A provider of day services must meet the
location
requirements of 130 CMR 630.436.
(6) Community Family Training and/or Residential Family Training. In order to
participate
as a provider of community family training and/or residential family training
under an HCBS
waiver, a provider must be an organization or an individual with experience in
providing
training and instruction about treatment regimes, behavior plans, and the use of
specialized
equipment that supports the waiver participant to participate in the community.
If an agency
or individual is providing activities where licensure or certification if
necessary, they must
have the necessary licensure and certifications.
(7) Home Accessibility Adaptations. In order to participate as a provider of
home
accessibility adaptations under an HCBS waiver, a provider must be qualified to
perform
environmental and minor home adaptations in accordance with applicable state and
local
building codes, comply with any applicable registration or licensure
requirements. Providers
must also be under contract with the MRC in accordance with its standards,
requirements,
policies, and procedures for the provision of home accessibility adaptations.
(8) Home Health Aide. In order to participate as a provider of home health aide
services
under an HCBS waiver, a provider must be an organization engaged in the business
of home
health aide services that meet the following requirements:
(a) employs registered nurses who have a current license by the Massachusetts
Board of
Registration in Nursing that supervise the home health aides; and
(b) employs home health aides who have certification in CPR and either a
certificate of
home health aide training or certificate of certified nurse’s aide training.
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(9) Homemaker. In order to participate as a provider of homemaker services under
an HCBS
waiver, a provider must be an individual homemaker or an organization engaged in
the
business of homemaker services that employs homemakers with at least one of the
following
qualifications:
(a) certificate of home health aide training;
(b) certificate of nurse’s aide training;
(c) certificate of 40-hour homemaker training; or
(d) certificate of 60-hour personal care training.
(10) Independent Living Supports. In order to participate as a provider of
independent
living supports services under an HCBS waiver, a provider must be a
site-based organization that ensures 24 hour seven days a week access to
supportive services
for participants who have intermittent, scheduled and unscheduled needs for
various forms
of assistance, but who do not require 24 hour supervision.
(11) Individual Support and Community Habilitation. In order to participate as a
provider of
individual support and community habilitation under an HCBS waiver, a provider
must be a
health or human service organization or an individual with experience providing
services
that are designed to develop, maintain, or maximize independent functioning in
self-care,
physical and emotional growth, socialization, communication, and vocational
skills for
persons with disabilities in accordance with all standards, requirements,
policies, and
procedures established by the MRC for the provision of such services.
(12) Peer Support. In order to participate as a provider of peer support
services under an
HCBS waiver, a provider must be an agency or individual with relevant
competencies and
experiences in peer support. For an agency providing this service, the agency
needs to
employ individuals who meet all relevant state and federal licensure or
certification
requirements in their discipline.
(13) Personal Care Services. In order to participate as a provider of personal
care services
under an HCBS waiver, a provider must be an individual personal care worker or
an
organization engaged in the business of
(a) providing assistance with the performance of activities of daily living to
persons
with disabilities in accordance with all standards, requirements, policies, and
procedures
established by the MRC for the provision of such service; and
(b) providing personal care services through personal care workers must have a
certificate in CPR and at least one of the following qualifications:
(i) certificate of home health aide training; or
(ii) certificate of nurse’s aide training; or
(iii) certificate of 60-hour personal care training.
(14) Prevocational Services. In order to participate as a provider of
prevocational services
under an HCBS waiver, a provider must be a prevocational service agency with
experience
in providing services that prepare a participant for paid or unpaid employment
in an
integrated, community setting.
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(15) Residential Habilitation. Residential habilitation under an HCBS waiver
must be
provided by organizations under contract with the MRC in accordance with its
standards,
requirements, policies, and procedures for the provision of residential
habilitation services to
persons with disabilities.
(16) Respite. In order to participate as a provider of respite services under an
HCBS waiver,
a respite provider must be
(a) licensed as a hospital by the Massachusetts Department of Public Health
under 105
CMR 130.00;
(b) certified as an assisted living residence by the Executive Office of Elder
Affairs
under 651 CMR 12.00;
(c) licensed as a nursing facility by the Massachusetts Department of Public
Health
under 105 CMR 153.00;
(d) able to meet site-based respite requirements established by the
Massachusetts
Department of Developmental Services under 115 CMR 7.00;
(e) licensed as a respite care facility by the Department of Developmental
Services
under 115 CMR 7.00;
(f) licensed as a rest home by the Massachusetts Department of Public Health
under 105
CMR 153.000; or
(g) enrolled in MassHealth as a participating adult foster care provider under
130 CMR
408.000.
(17) Self-Directed Services. Participants who choose to self-direct waiver
services will have
the authority and responsibility for recruiting and hiring workers to provide
their Self-
Directed Services, subject to the standards, requirements, policies and
procedures for the
hiring of such workers under the participant’s HCBS Waiver.
(18) Shared Home Supports. In order to participate as a provider of shared home
supports, a
provider must be an organization under contract with the MRC in accordance with
its
standards, requirements, policies, and procedures for the provision of shared
home support
services to persons with disabilities
(19) Shared Living – 24 Hour Supports. In order to participate as a provider of
shared living
– 24 hour supports under an HCBS waiver, organizations under contract with the
MRC in
accordance with its standards, requirements, policies, and procedures for the
provision of
shared living – 24 hour supports services to persons with disabilities.
(20) Skilled Nursing. In order to participate as a provider of skilled nursing
services under
an HCBS waiver, a provider must be an organization engaged in the business of
providing
nursing services that employ nurses who are a registered nurse or a licensed
practical nurse
by the Massachusetts Board of Registration in Nursing.
(21) Specialized Medical Equipment. In order to participate as a provider of
specialized
medical equipment and supplies under an HCBS waiver, a provider must be an
individual or
entity engaged in the business of furnishing durable medical equipment,
medical/surgical
supplies, or customized equipment, or a provider participating in MassHealth
under 130
CMR 409.000 or a pharmacy participating in MassHealth under 130 CMR 406.000.
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(22) Supported Employment. In order to participate as a provider of supported
employment
services under an HCBS waiver, a provider must be a human service organization
with
experience providing supported employment programs in accordance with all
standards,
requirements, policies, and procedures established by the MRC for the provision
of
supported employment to persons with disabilities.
(23) Supportive Home Care Aide. In order to participate as a provider of
supportive home
care aide services under a HCBS waiver, a provider must be an organization
engaged in the
business of supportive home care aide services that employs supportive home care
aides
who:
(a) have certification in CPR and either a certificate of home health aide
training or
certificate of certified nurse’s aide training; and
(b) have completed an additional 12 hours of training in the area of serving
individuals
with behavioral health needs or the 12 hour training developed by the
Alzheimer’s
Association, Massachusetts Chapter on serving individuals with Alzheimer’s
disease or
related disorders.
(24) Therapy Services.
(a) Occupational Therapy. In order to participate as a provider of occupational
therapy
under an HCBS waiver, a provider must be an occupational therapist participating
in the
MassHealth program under 130 CMR 432.000, a rehabilitation center participating
in
MassHealth under 130 CMR 430.600, or a home health agency participating in
MassHealth under 130 CMR 403.000.
(b) Physical Therapy. In order to participate as a provider of physical therapy
under an
HCBS waiver, a provider must be a physical therapist participating in the
MassHealth
program under 130 CMR 432.000, a rehabilitation center participating in
MassHealth
under 130 CMR 430.600, or a home health agency participating in MassHealth under
130 CMR 403.000.
(c) Speech Therapy. In order to participate as a provider of speech therapy
under an
HCBS waiver, a provider must be a speech/language therapist participating in
MassHealth under 130 CMR 432.000, a speech and hearing center participating in
MassHealth under 130 CMR 413.000, a rehabilitation center participating in
MassHealth
under 130 CMR 430.600, or a home health agency participating in MassHealth under
130 CMR 403.000.
(25) Transitional Assistance. Transitional assistance under an HCBS waiver must
be
provided by organizations under contract with the MRC in accordance with its
standards,
requirements, policies, and procedures for the provision of transitional
assistance services to
persons with disabilities.
(26) Transportation. In order to participate as a provider of transportation
under an HCBS
waiver, a provider must be an organization engaged in the business of
transporting persons
with disabilities in accordance with all standards, requirements, policies, and
procedures
established by the MRC for the provision of such services.
(27) Vehicle Modification. In order to participate as a provider of vehicle
modifications
under an HCBS waiver, a provider must be an individual or organization engaged
in the
business of vehicle modification and be under contract with the MRC for the
provision of
vehicle modification to persons with disabilities.
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MassHealth
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Subchapter Number and Title
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(130 CMR 630.000)
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HCBS-1
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630.405: HCBS Waiver Coverage Types
A participant is eligible for HCBS waiver services according to the applicable
HCBS waiver
under which the participant is enrolled. See 130 CMR 519.007. Each HCBS waiver
coverage
type is described below. Payment for the covered services listed in 130 CMR
630.000 is subject
to all conditions and restrictions of MassHealth, including all applicable
prerequisites for
payment.
(A) Acquired Brain Injury with Residential Rehabilitation (ABI-RH) Waiver. The
following ABI
waiver services are covered for eligible MassHealth members who are enrolled as
participants
under the ABI-RH Waiver:
(1) residential habilitation;
(2) supported employment;
(3) community-based substance abuse treatment;
(4) day services;
(5) occupational therapy;
(6) physical therapy;
(7) specialized medical equipment;
(8) speech therapy;
(9) transitional assistance; and
(10) transportation.
(B) Acquired Brain Injury Non-Residential Habilitation (ABI-N) Waiver. The
following ABI
waiver services are covered for eligible MassHealth members who are enrolled as
participants
under the ABI-N Waiver:
(1) homemaker;
(2) personal care;
(3) respite;
(4) supported employment;
(5) adult companion;
(6) chore;
(7) community-based substance abuse treatment;
(8) day services;
(9) home accessibility adaptations;
(10) individual support and community habilitation;
(11) occupational therapy;
(12) physical therapy;
(13) specialized medical equipment;
(14) speech therapy;
(15) transitional assistance; and
(16) transportation.
(C) Money Follows the Person Residential Supports (MFP-RS) Waiver. The following
HCBS
waiver services are covered for eligible MassHealth members who are enrolled as
participants
under the MFP-RS Waiver:
(1) assisted living services;
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(2) behavioral health diversionary services;
(3) day services;
(4) home accessibility adaptations;
(5) individual support and community habilitation;
(6) occupational therapy;
(7) peer support;
(8) physical therapy;
(9) prevocational services;
(10) residential family training;
(11) residential habilitation;
(12) shared living – 24 hour supports;
(13) skilled nursing;
(14) specialized medical equipment;
(15) speech therapy;
(16) supported employment; and
(17) transportation.
(D) Money Follows the Person Community Living (MFP-CL) Waiver. The following
HCBS
waiver services are covered for eligible MassHealth members who are enrolled as
participants
under the MFP-CL Waiver:
(1) adult companion;
(2) behavioral health diversionary services ;
(3) chore;
(4) community family training;
(5) day services;
(6) home accessibility adaptations;
(7) homemaker;
(8) home health aide;
(9) independent living supports;
(10) individual support and community habilitation;
(11) occupational therapy;
(12) peer support;
(13) personal care;
(14) physical therapy;
(15) prevocational services;
(16) respite;
(17) shared home supports;
(18) skilled nursing;
(19) specialized medical equipment;
(20) speech therapy;
(21) supported employment;
(22) supportive home care aide;
(23) transportation; and
(24) vehicle modification.
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MassHealth
Provider Manual Series
Subchapter Number and Title
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(130 CMR 630.000)
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Transmittal Letter
HCBS-1
Date
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630.406: HCBS Waiver Conditions for Payment
(A) The MassHealth agency pays an HCBS waiver provider for the provision of
waiver services
in accordance with the applicable payment methodology and rate schedule
established by the
Executive Office of Health and Human Services (EOHHS) or by the MassHealth
agency.
(B) Payment for services is subject to the conditions, exclusions, and
limitations set forth in 130
CMR 630.000 and 450.000.
(C) The MassHealth agency pays an HCBS waiver provider for a waiver service only
if
(1) the member was enrolled as a participant under one of the HCBS waivers on
the date of
service;
(2) the service billed was appropriate and necessary;
(3) the service billed was authorized and included in the service plan for the
participant
pursuant to 130 CMR 630.409(A); and
(4) the waiver services were provided by an HCBS waiver provider in accordance
with the
requirements of 130 CMR 630.000 and 450.000.
(D) Additional conditions of payment for waiver services by service type are
located as
applicable in 130 CMR 630.410 through 630.435.
(E) Self Directed Services. Participants who self-direct their services will
submit timesheets to
the fiscal intermediary (FI) for each worker who provided self-directed
services. The FI reviews
the time sheets and verifies that they are in accordance with the participant’s
service plan and that
payment is permissible. The FI sends approved payments to the participant who is
responsible for
making payment to the worker for the self-directed services.
630.407: HCBS Waiver Coverage Requirements
(A) Limitations on Covered Services. The MassHealth agency pays for HCBS waiver
services
provided to a participant who resides in a home or community-based setting,
which may include,
without limitation, a temporary residence. With the exception of respite
services, as described in
130 CMR 630.425, and transitional assistance, as described in 130 CMR 630.433,
the
MassHealth agency does not pay for HCBS waiver services provided to a
participant who is a
resident or inpatient of a hospital, nursing facility, intermediate care
facility for the mentally
retarded, or any other medical facility subject to state licensure or
certification.
(B) Least Costly Form of Care. The MassHealth agency pays for HCBS waiver
services only
when services are the least costly form of comparable care available in the
community.
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(130 CMR 630.000)
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HCBS-1
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630.408: Nonpayable Services
(A) The MassHealth agency does not pay for any HCBS waiver services that are
furnished
before the development of the service plan or that are not included in a
participant’s service plan
pursuant to 130 CMR 630.409(A).
(B) The MassHealth agency does not pay for HCBS waiver services that are
provided to any
individual other than the participant who is eligible to receive such services
and for whom such
services are approved in the service plan.
(C) The MassHealth agency does not pay an HCBS waiver provider for
(1) any service that is not listed as a covered service for the participant
under 130 CMR
630.405;
(2) any service that is not authorized in the service plan;
(3) any service to a person who is a resident or inpatient of a hospital,
nursing facility,
intermediate care facility for the mentally retarded, or any other medical
facility subject to
state licensure or certification, except for respite services, in accordance
with 130 CMR
630.425, and transitional assistance, in accordance with 130 CMR 630.433;
(4) any service to a participant who is receiving a service from another home-
and
community-based waiver program;
(5) the cost of room and board, unless provided as part of respite care in
accordance with
130 CMR 630.425;
(6) the cost of maintenance, upkeep, an improvement, or home accessibility
adaptations to a
residential habilitation site, group home, or other residential facility; and
(7) the cost of maintenance, upkeep, or an improvement to a participant’s place
of residence,
except for home accessibility adaptations in accordance with 130 CMR 630.416,
and
transitional assistance in accordance with 130 CMR 630.433.
(D) The MassHealth agency does not pay for HCBS waiver services furnished by
legally
responsible individuals as defined in 130 CMR 630.402.
(E) The MassHealth agency does not pay for HCBS waiver services that are unsafe,
inappropriate, or unnecessary for a participant. Each HCBS waiver provider is
responsible for
ensuring that the HCBS waiver services it provides are safe, appropriate, and
necessary for the
participant.
(F) The MassHealth agency does not pay for HCBS waiver services in excess of the
units
identified and authorized in the participant’s service plan.
(G) The MassHealth agency does not pay for HCBS waiver services that duplicate
care provided
by another payment source or by a family member or legally responsible
individual as defined in
130 CMR 630.402.
(H) Additional information about nonpayable services by service type is located
as applicable in
130 CMR 630.411 through 630.435.
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(130 CMR 630.000)
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630.409: Service Plan and Notice of Approval or Denial of HCBS Waiver Services
(A) Service Plan. The MassHealth agency or its designee assigns a case manager
to each
participant under an HCBS waiver. The case manager develops the service plan in
consultation
with the participant, his or her authorized representative, if any, and other
appropriate
professionals. The service plan must contain, at a minimum, the types of HCBS
waiver services
to be furnished, the amount, frequency, and duration of each service, and the
type of provider to
furnish each service. The service plan may not be backdated.
(B) Notice of Approval. For all HCBS waiver services authorized and included in
a service plan,
the MassHealth agency or its designee will provide a copy of the service plan to
the participant.
The service plan must contain, at a minimum, the types of HCBS waiver services
to be furnished,
the amount, frequency, and duration of each service, and the effective date of
the authorization.
(C) Notice of Denial or Modification and Right of Appeal.
(1) A participant and the participant’s authorized representative, as
applicable, will receive a
written notification from the MassHealth agency or its designee whenever a
service plan
contains a denial or modification of a requested HCBS waiver service requested
by a
participant. The notification will describe the reason for the denial or
modification and
provide information to the participant about the participant’s right to appeal
and the appeal
procedure.
(2) A participant may request a fair hearing whenever the MassHealth agency or
its
designee denies or modifies the participant’s request for an HCBS waiver
service. As used in
130 CMR 630.409, a denial or modification includes the MassHealth agency’s
denial,
suspension, reduction, or termination of a requested HCBS waiver service as well
as the
agency’s failure to act on the participant’s request for an HCBS waiver service
within 30
days of receiving such request. The participant must request a fair hearing in
writing within
the time limits set forth in 130 CMR 610.015(B)(1) or (2), as applicable. The
Office of
Medicaid Board of Hearings conducts the hearing in accordance with 130 CMR
610.000.
(D) Information for HCBS Waiver Providers. The MassHealth agency or its designee
will
furnish applicable information from each service plan to an HCBS waiver provider
that provides
an HCBS waiver service to a participant. Applicable information will include the
amount,
frequency, duration, and effective date of the HCBS waiver service that is
authorized in the
service plan. The information will be provided in a manner and format specified
by the
MassHealth agency or its designee.
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Subchapter Number and Title
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(130 CMR 630.000)
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(E) Information for Fiscal Intermediary (FI). Waiver participants will be given
the option to self-
direct certain waiver services as specified in the particular HCBS waiver in
which they are
enrolled. Participants who choose to self-direct will have those self-directed
waiver services
listed in their service plan. Information regarding the frequency and duration
of the self-directed
services in the service plan is forwarded to the FI. The information will be
provided in a manner
and format specified by the MassHealth agency or its designee.
630.410: Adult Companion
(A) Conditions of Payment. Adult companion services must be provided in
accordance with a
therapeutic goal in the service plan. Adult companion services are covered where
the adult
companion enables the participant to function with greater independence within
the participant’s
home or community.
(B) Nonpayable Services. Adult companion services are not covered where the
services are
purely recreational or diversionary in nature.
630.411: Assisted Living Services
(A) Conditions of Payment. Assisted Living services are covered when the
participant requires
personal care and supportive services (homemaker, chore, personal care services,
and meal
preparation) and the availability of 24-hour on-site response capability to meet
scheduled or
unpredictable resident needs.
(B) Nonpayable Services. Payment is not made for the cost of room and board,
including items of
comfort or convenience, or the costs of facility maintenance, upkeep and
improvement. Assisted
living services do not include, and payment will not be made for, 24-hour
skilled care. Duplicative
waiver and state plan services are not available to participants receiving
assisted living services.
The following waiver services are not available to participants receiving
assisted living services:
chore, homemaker, personal care, home health aide, and supportive home care
aide.
630.412: Chore Services
(A) Conditions of Payment. Chore services are covered only on a one-time-only or
infrequent
basis and only when an unusual household task is required to be performed to
maintain a
participant’s home in a clean, sanitary, and safe condition.
(B) Nonpayable Services. Chore services are not covered when the participant or
someone else
in the household is capable of performing the tasks or when a relative,
caregiver, landlord,
community/volunteer agency, or third-party payer is capable of or responsible
for provision of
the tasks. In the case of rental property, the responsibility of the landlord,
pursuant to a lease
agreement, is examined before authorizing any chore services in a service plan.
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Subchapter Number and Title
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(130 CMR 630.000)
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630.413: Community-Based Substance Abuse Treatment
(A) Conditions of Payment. Community-based substance abuse treatment is covered
when a
participant is determined to need substance abuse treatment services in a
community setting and
is able to appropriately take part in a residential rehabilitation substance
abuse treatment and
education program for adults, as identified and authorized in the participant’s
service plan.
(B) Nonpayable Services. Pursuant to 130 CMR 630.404(D)(4), community-based
substance
abuse treatment may be provided only by private organizations that operate
freestanding
residential rehabilitation substance abuse treatment and education programs for
adults. These
services may not be provided in any unit that is licensed as a hospital, nursing
facility, or similar
medical facility.
630.414: Community Family Training and Residential Family Training
(A) Conditions of Payment. Documentation in the participant’s record must
demonstrate the benefit
of this service to the participant. Community family training and residential
family training is not
available for individuals who are employed to care for the participant. Family
training may be
provided in a small group format or the family trainer may provide individual
instruction to a
specific family based on the needs of the family to understand the specialized
needs of the waiver
participant. The one-to-one family training is instructional; it is not
counseling.
1.
Community Family Training: For purpose of this service, “family” is defined as
the
persons who live with or provide unpaid care to a waiver participant and may
include a
parent or other relative.
2.
Residential Family Training: For purpose of this service, “family” is defined as
the
persons who provide unpaid care to a waiver participant and may include a parent
or
other relative.
(B) Nonpayable Services.
1.
Community Family Training: This service is not available to those participants
who do
not live in the family home or do not regularly visit with their family.
2.
Residential Family Training: This service is not available in provider operated
residential
habilitation or assisted living sites or in shared living settings unless the
participant
regularly leaves the site to visit his or her family.
630.415: Day Services
(A) Conditions of Payment. Day services are covered for participants who need a
structured day
activity program and who are not interested in employment or not ready to join
the general
workforce.
(B) Recordkeeping. In addition to the requirements of 130 CMR 630.439, the
provider must
maintain records that include detailed descriptions of day services provided and
documentation
of all units of services.
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Subchapter Number and Title
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(130 CMR 630.000)
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Transmittal Letter
HCBS-1
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630.416: Home Accessibility Adaptations
(A) Conditions of Payment.
(1) Home accessibility adaptations are covered only when the participant would
be unable to
reside in the participant’s home without the accessibility adaptations and the
adaptations
would enable the participant to function with greater independence within the
participant’s
home.
(2) All home accessibility adaptations must be provided in accordance with
applicable state
and local building codes.
(B) Nonpayable Services. Home accessibility adaptations are not covered when the
adaptations
(1) bring a substandard dwelling up to minimum standards or to make improvements
to a
residence that are of general utility (for example, new carpeting, roof repairs,
or central air
conditioning) and are not of direct medical or remedial benefit to the
participant;
(2) are required by law to be made by a landlord or other third party;
(3) are made to a residential habilitation site, group home, or other
residential facility; or
(4) add to the total square footage of the home, except when necessary to
complete an
adaptation (for example, in order to improve entrance and egress to a residence
or to
configure a bathroom to accommodate a wheelchair).
630.417: Homemaker
(A) Conditions of Payment. Homemaker services are covered under the ABI waiver
on a short-
term or periodic basis when the individual regularly responsible for these
activities is temporarily
absent or unable to manage the home and care for the participant.
(B) Nonpayable Services. Homemaker services are not covered when the participant
or someone
else in the household is capable of performing the tasks or when a relative,
caregiver, landlord,
community/volunteer agency, or third party payer is capable of or responsible
for homemaking
tasks.
630.418: Home Health Aide
(A) Conditions of Payment.
(1) Home health aide services are covered when the participant requires a range
of assistance
with ADLs and IADLS related to independent living and when the home health aide
service enables the participant to function with greater independence within the
participant’s home and community.
(2) Home health aide services are covered under the waiver if the home health
aide receives
supervision by a registered nurse with a current license by the Massachusetts
Board of
Registration in Nursing.
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Subchapter Number and Title
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(130 CMR 630.000)
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(B) Nonpayable Services. Home health aide services are not covered when
duplicative services
are provided to the waiver participant.
630.419: Independent Living Supports:
(A) Conditions of Payment.
(1) Independent Living Supports are covered when the participant requires
assistance with
intermittent, scheduled and unscheduled needs for ADLs, IADLs, support and
companionship, emotional support and socialization.
(2) The independent living supports service provider cannot be the owner of the
building in
which the services are delivered to the waiver participant.
(B) Nonpayable Services. Duplicative services, including, but not limited to
waiver homemaker,
personal care, adult companion, shared home supports, and supportive home care
aide, are not
available to participants receiving independent living supports services.
630.420: Individual Support and Community Habilitation
(A) Conditions of Payment.
(1) Individual support and community habilitation is covered when a participant
needs
assistance to develop, maintain, or maximize independent functioning in self-
care, physical
and emotional growth, socialization, communication, and vocational skills. This
service
includes training and education in self-determination and self-advocacy to
enable the
participant to acquire skills to exercise control and responsibility over the
services and
supports they receive, and to become more independent, integrated, and
productive in the
community.
(2) Individual support and community habilitation may be provided regularly or
intermittently. These services may not be provided on a 24-hour basis, and must
be
determined necessary for the participant to remain in the community, as
documented in the
participant’s service plan.
(B) Recordkeeping. In addition to the requirements of 130 CMR 630.439, the
provider must
maintain records that include detailed descriptions of individual support and
community
habilitation services provided and documentation of all units of services.
630.421: Peer Support
(A) Conditions of Payment. Peer support services are covered up to a maximum of
16 hours per
week when it:
(1) is instructional and not counseling;
(2) enhances the skills of the participant to function in the community; and
(B) Recordkeeping. In addition to the requirements of 130 CMR 630.439, the
provider must
maintain documentation in the participant’s record that demonstrates the benefit
of this service to
the participant.
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Subchapter Number and Title
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(130 CMR 630.000)
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630.422: Personal Care Services
(A) Conditions of Payment. Personal care services are covered when the
participant requires a
range of assistance with ADLs related to independent living and when the
personal care service
enables the participant to function with greater independence within the
participant’s home and
community. Personal care services under an HCBS waiver may include supervision
and cuing of
participants as well as. Personal care services may also include assistance with
IADLs. Personal
care services provided under a HCBS waiver may not duplicate personal care
services provided
under the state plan.
(B) Recordkeeping. In addition to the requirements of 130 CMR 630.431, the
provider must
maintain records that include detailed descriptions of personal care services
provided and
documentation of all units of services.
630.423: Prevocational Services
(A) Conditions of Payment.
(1) Prevocational services are covered when the participant requires
habilitative or
rehabilitative services, rather than explicit employment training, as specified
in the
participant’s service plan. These services may be provided one-to-one or in a
group format.
This service may be provided as a site-based service, in community settings or
in a
combination of these settings and must include integrated community activities
that support
development of vocational needs.
(2) The amount, duration and scope of prevocational services provided to a
participant is
based on the participant’s pre-employment needs that arise as a result of their
functional
limitations and condition, including services that enable the participant to
acquire, improve,
retain/maintain, and prevent deterioration of functioning consistent with the
participant’s
interest, strengths, priorities, abilities and capabilities.
(B) Recordkeeping. In addition to the requirements of 130 CMR 630.439, the
provider must
have documentation in the participant’s file that the service the participant
received is not
available under a program funded under section 110 of the Rehabilitation Act of
1973 or the
IDEA (20 U.S.C. 1401 et seq.).
630.424: Residential Habilitation
(A) Conditions of Payment. Residential habilitation is covered solely when
authorized in the
participant’s service plan. Residential habilitation is covered when a
participant requires ongoing
services and supports delivered to a participant in a provider-operated 24-hour
staffed residential
setting.
(B) Nonpayable Services. Residential habilitation is not covered for
participants who live with
their immediate family unless the immediate family (for example, grandparent,
parent, sibling, or
spouse) is also eligible for residential habilitation and, if applicable, has
received prior
authorization from the MassHealth agency or its designee for residential
habilitation. The
following waiver services are not available to participants receiving
Residential Habilitation:
Assisted Living, Shared Living – 24 Hour Supports.
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(C) Payer for Residential Habilitation. The MRC pays providers for residential
habilitation.
630.425: Respite
(A) Conditions of Payment. Respite care is covered solely to provide temporary
relief to non-
paid caregivers when the participant requires assistance with activities related
to independent
living.
(B) Nonpayable Services.
(1) Respite care is not covered for the purpose of compensating relief or
substitute staff for a
paid service provider.
(2) Respite care is not covered for any time period during which other
assistance with
activities related to independent living is available to a participant.
630.426: Shared Home Supports
(A) Conditions of Payment.
(1) Shared home supports provide daily structure, skills training and
supervision, but does
not include 24-hour care.
(2) The shared home supports provider must match a participant with a shared
home
supports caregiver. The caregiver lives with the participant at the residence of
the caregiver
or the participant.
(3) Shared home supports include supportive services that assist with the
acquisition,
retention, or improvement of skills related to living in the community. This
includes such
supports as: adaptive skills development, assistance with ADLs and IADLs, adult
educational supports, social and leisure skill development.
(4) The shared home supports provider must provide regular and ongoing oversight
and
supervision of the caregiver.
(5) Shared home supports may be provided to no more than two participants in a
home.
(B) Nonpayable Services.
(1) Shared home supports is not available to participants who live with their
immediate
family unless the immediate family member is also eligible for shared home
supports and
had received authorization in their service plan for shared home supports.
(2) Duplicative services are not available to participants receiving shared home
supports
services.
(3) Payment is not made for the cost of room and board, including the cost of
building
maintenance, upkeep and improvement.
(C) Payer for Shared Home Supports. The MRC pays providers for shared home
supports.
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(130 CMR 630.000)
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630.427: Shared Living – 24 Hour Supports
(A) Conditions of Payment.
(1) Shared Living – 24 Hour Supports is a residential service that provides 24
hour seven
days per week supportive service.
(2) Shared Living – 24 Hour Supports integrates the participant into the usual
activities of
the caregiver’s family life. In addition, there will be opportunities for
learning, developing
and maintaining skills including in such areas as ADLs, IADLs, social and
recreational
activities, and personal enrichment.
(3) The caregiver lives with the participant at the residence of the caregiver
or the
participant. Shared Living agencies recruit caregivers, assess their abilities,
coordinate
placement of participant or caregiver, train and provide guidance, supervision
and oversight
for caregivers and provide oversight of participants’ living situations. The
caregiver may not
be a legally responsible family member.
(4) The Shared Living – 24 Hour Supports provider must provide regular and
ongoing
oversight and supervision of the caregiver.
(5) Shared Living – 24 Hour Supports may be provided to no more than two
participants in a
home.
(B) Nonpayable Services.
(1) Shared Living – 24 Hour Supports is not available to individuals who live
with their
immediate family unless the immediate family member (grandparent, parent,
sibling or
spouse) is also eligible for Shared Living – 24 Hour Supports and had received
prior
authorization, as applicable, for Shared Living – 24 Hour Supports.
(2) Duplicative waiver and state plan services are not available to participants
receiving
Shared Living – 24 Hour Supports services.
(3) Payment is not made for the cost of room and board, including the cost of
building
maintenance, upkeep and improvement.
(C) Payer for Shared Living – 24 Hour Supports. The MRC pays providers for
shared living – 24
hour supports.
630.428: Skilled Nursing
(A) Conditions of Payment. Skilled nursing services listed in a participant’s
service plan must be
provided within the scope of the State’s Nurse Practice Act.
(B) Nonpayable Services.
(1) This service is limited to one skilled nursing visit per week per
participant. The MassHealth
agency or its designee may authorize an exception to the limit on a temporary
basis to facilitate
transitions to a community setting, to ensure that a participant at risk for
medical facility
admission is able to remain in the community, or to otherwise stabilize a
participant’s medical
condition.
(2) Skilled nursing services are not covered when duplicative nursing services
are provided to the
participant.
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Provider Manual Series
Subchapter Number and Title
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(130 CMR 630.000)
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630.429: Specialized Medical Equipment
(A) Payable Services. Covered specialized medical equipment includes
(1) devices, controls, or appliances that enable a participant to increase his
or her ability to
perform daily living activities or to perceive, control, or communicate with the
environment
or to perceive or communicate with other people;
(2) medical equipment necessary to address physical conditions or participant
functional
limitations; and
(3) ancillary supplies and equipment necessary for the proper functioning of
specialized
items.
(B) Conditions of Payment. Specialized medical equipment must
(1) not be covered under 130 CMR 406.000 or 409.000;
(2) meet applicable standards of manufacture, design, and installation; and
(3) have been examined or tested by Underwriters Laboratories (or other
appropriate
organization), and comply with FCC regulations, as appropriate.
(C) Nonpayable Services. Items that are not of direct medical or remedial
benefit to a participant
are not covered.
630.430: Supported Employment
(A) Service Limitations. When supported employment services are provided at a
work site where
persons without disabilities are employed, payment is made only for the
adaptations, supervision,
and training required by participants as a result of their disabilities.
(B) Nonpayable Services.
(1) Payment for supported employment does not include incentive payments,
subsidies, or
unrelated vocational training expenses, including but not limited to the
following exclusions:
(a) incentive payments made to an employer to encourage or subsidize the
employer's
participation in a supported employment program;
(b) payments that are passed through to users of supported employment programs;
or
(c) payments for training that is not directly related to a participant's
supported
employment needs.
(2) Supervisory activities performed as a normal part of the business setting
are not covered.
(C) Recordkeeping. In addition to the requirements of 130 CMR 630.439, each
provider of
supported employment services must maintain documentation in the file of each
participant
receiving this service that the service is not available under a program funded
under section 110
of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education
Act (20 U.S.C.
1401 et seq.).
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(130 CMR 630.000)
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630.431: Supportive Home Care Aide
(A) Conditions of Payment. Supportive home care aide is covered when a
participant needs
assistance with ADLs and IADLs, in addition to providing emotional support,
socialization, and
escort services to participants with Alzheimer’s Disease/Dementia or behavioral
health needs.
(B) Nonpayable Services. Supportive home care aide services are not covered when
duplicative
services are provided to the waiver participant.
630.432: Occupational Therapy, Physical Therapy, and Speech Therapy
(A) Occupational Therapy.
(1) Conditions of Payment. Occupational therapy is covered when:
(a) authorized and included in the participant’s service plan;
(b) appropriate and necessary for the participant to improve, develop, correct,
rehabilitate, or prevent the worsening of physical functions that have been
lost, impaired
or reduced as a result of acute or chronic medical conditions, congenital
anomalies or
injuries; or required to maintain or prevent the worsening of function;
(c) of such a level of complexity and sophistication that the judgment,
knowledge, and
skills of a licensed occupational therapist are required;
(d) performed by a licensed occupational therapist, or by a licensed
occupational
therapy assistant under the supervision of a licensed occupational therapist;
and
(e) not be covered under 130 CMR 403.000 or 432.000.
(2) Nonpayable Services. Services that are not of direct medical or remedial
benefit to a
participant are not covered by MassHealth.
(B) Physical Therapy.
(1) Conditions of Payment. To be covered under the ABI waiver, physical therapy
must
(a) be authorized and included in the participant’s service plan;
(b) be appropriate and necessary for the participant to improve, develop,
correct,
rehabilitate, or prevent the worsening of physical functions that have been
lost,
impaired, or reduced as a result of acute or chronic medical conditions,
congenital
anomalies, or injuries; or required to maintain or prevent the worsening of
function;
(c) be of such a level of complexity and sophistication that the judgment,
knowledge,
and skills of a licensed physical therapist are required;
(d) be performed by a licensed physical therapist, or by a licensed physical
therapy
assistant under the supervision of a licensed physical therapist; and
(e) not be covered under 130 CMR 403.000 or 432.000.
(2) Nonpayable Services. Services that are not of direct medical or remedial
benefit to a
participant are not covered by MassHealth.
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(130 CMR 630.000)
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(C) Speech Therapy.
(1) Conditions of Payment. Speech therapy is covered when
(a) authorized and included in the participant’s service plan;
(b) appropriate and necessary for the participant to improve, develop, correct,
rehabilitate, or prevent the worsening of physical functions that have been
lost, impaired
or reduced as a result of acute or chronic medical conditions, congenital
anomalies or
injuries; or required to maintain or prevent the worsening of function;
(c) be of such a level of complexity and sophistication that the judgment,
knowledge,
and skills of a licensed speech/language therapist are required;
(d) be performed by a licensed speech/language therapist; and
(e) not be covered under 130 CMR 403.000, 413.000, or 432.000.
(2) Nonpayable Services. Services that are not of direct medical or remedial
benefit to a
participant are not covered by MassHealth.
(D) Maintenance Program.
(1) The MassHealth agency pays for the establishment of a maintenance program
and for
the training of the participant, the participant’s family, or other persons to
carry it out, as part
of a regular treatment visit, not as a separate service.
(2) In certain instances, the specialized knowledge and judgment of a licensed
therapist may
be required to perform services that are part of a maintenance program, to
ensure safety or
effectiveness that may otherwise be compromised due to the participant’s medical
condition.
At the time the decision is made that the services must be performed by a
licensed therapist,
all information that supports the appropriateness and necessity for performance
of such
services by a licensed therapist, rather than a non-therapist, must be
documented in the
manner and format designated by the MassHealth agency or its designee.
630.433: Transitional Assistance
(A) Services and Expenses Included Under Transitional Assistance Services.
Transitional
assistance consists of the following items, when appropriate and necessary for
the participant’s
discharge from a nursing facility or hospital and safe transition to the
community:
(1) security deposits that are required to obtain a lease on an apartment or
home;
(2) essential household furnishings and moving expense required to occupy and
use a
community domicile, including furniture, window coverings, food preparation
items, and
bed/bath linens;
(3) set-up fees or deposits for utility or service access, including telephone,
electricity,
heating, and water;
(4) household services necessary for the individual’s health and safety, such as
pest
eradication and one-time cleaning prior to occupancy;
(5) moving expenses; and
(6) home accessibility adaptations needed for discharge from a hospital or
nursing facility.
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Provider Manual Series
Subchapter Number and Title
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(130 CMR 630.000)
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(B) Conditions of Payment. To qualify for payment as transitional assistance
services, expenses
must be
(1) authorized and included in the participant’s service plan;
(2) incurred within 60 days before a participant’s discharge from a nursing
facility or
hospital or another provider-operated living arrangement; and
(3) necessary for the participant’s safe transition to the community.
(C) Nonpayable Services and Expenses. Transitional assistance services does not
include
expenses
(1) for monthly rental or mortgage expense; food, regular utility charges;
and/or household
appliances or items that are intended for pure diversion or recreational
purposes;
(2) for residential facilities that are owned or leased by an HCBS waiver
provider; or
(3) that are not necessary for the participant’s safe transition to the
community.
(D) Payer for Transitional Assistance Services. The MRC pays providers for
transitional
assistance services.
630.434: Transportation
(A) Driver and Vehicle Requirements.
(1) All driver’s must have a valid driver’s license, appropriate for the type
and class of
vehicle used to transport HCBS waiver participants.
(2) All vehicles must be insured and documentation of vehicle and liability
insurance must
be provided.
(3) Transportation providers must provide written certification of
(a) vehicle maintenance;
(b) age of vehicles; and
(c) passenger capacity of vehicles.
(4) Transportation providers must be duly registered with the Massachusetts
Registry of
Motor Vehicles and must meet all safety and inspection requirements of the
Registry.
(5) All accessible vehicles specifically equipped to carry one or more persons
who are
mobility-impaired or using a wheelchair must be equipped with applicable safety
equipment
to secure a wheelchair and all drivers must be trained in the use of vehicle
lifts and safety
equipment.
(6) All vehicles must be maintained in such a manner as to ensure the safety and
comfort of
the passengers being transported. Such vehicles must be clean, sanitary, vermin
free, and
protected against motor-exhaust fumes. The vehicle must carry no more than the
number of
passengers for which it was designed, in accordance with local town or city
licensing
regulations.
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MassHealth
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Subchapter Number and Title
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(130 CMR 630.000)
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(B) Conditions of Payment. Transportation services are covered only to the
extent that they
enable a waiver participant to gain access to waiver and other community
services, activities, and
resources, as specified in the participant’s service plan.
630.435: Vehicle Modification
(A) Conditions of Payment.
(1) Vehicle modifications, to an automobile or van which is the participant’s
primary means of
transportation, are covered when such adaptations or alterations are:
(a) made in order to accommodate the special needs of the participant;
(b) necessary to enable the participant to integrate more fully into the
community; and
(c) required to ensure the health, welfare and safety of the participant.
(2) The need for vehicle modification must be documented in the participant’s
service plan,
subject to the MRC requirements and approved for payment by the MRC.
(B) Nonpayable Services. The following are specifically excluded vehicle
modifications:
(1) Adaptations or improvements to the vehicle that are of general utility, and
are not of direct
medical or remedial benefit to the participant.
(2) Adaptations or improvements to a vehicle that is owned or leased by an
entity providing
services to the participant.
(3) Purchase or lease of a vehicle. However, payment for adaptations to a new
van or vehicle
purchased or leased by a participant or family can be made available at the time
of purchase or
lease to accommodate the special needs of the participant.
(4) Regularly scheduled upkeep and maintenance of a vehicle, except upkeep and
maintenance of
the adaptations.
(5) Cost can not exceed the cost limit for the service as provided under the
HCBS waiver in
which the participant is enrolled.
(6) Modifications to a paid caregiver’s vehicle or provider agency vehicle are
excluded.
(C) Payer for Vehicle Modification Services. The MRC pays providers for Vehicle
Modification
services.
630.436: Location Requirements for HCBS Waiver Providers
(A) Any location that is owned or operated by an HCBS waiver provider where HCBS
waiver
services are provided must meet all applicable building, sanitary, health,
safety, and zoning
requirements.
(1) All HCBS waiver providers must ensure that the location in which HCBS waiver
services are provided is clean, environmentally safe, free of vermin and obvious
fire and
chemical hazards, maintained in accordance with common fire safety practices,
and of
sufficient size to accommodate comfortably the number of individuals and staff
it serves.
Any objects or conditions that represent a fire hazard greater than that which
could be
expected of ordinary household furnishings is not permitted.
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(2) All HCBS waiver providers must ensure that the location in which HCBS waiver
services are provided is a barrier-free environment in those areas used by
persons with
substantial mobility impairment, to the extent necessary to permit access to the
supports,
services, personal, and common areas. A location is deemed barrier free, in
whole or part, if
it meets the applicable standards of the Architectural Access Board (521 CMR) as
adopted in
the Massachusetts State Building Code (780 CMR).
(B) A location where day services are provided must meet the site requirements
of 130 CMR
404.000 or 419.000 or the licensure/certification standards of an EOHHS agency
for day services
(such as Department of Developmental Services requirements at 115 CMR 7.00 and
8.00 or
Department of Mental Health requirements at 104 CMR 28.00 Subpart B) or the site
requirements established by the MRC for the provision of day services to persons
with acquired
brain injuries.
630.437: Personnel Requirements and Responsibilities of HCBS Waiver Providers
(A) Personnel Hiring Requirements. The requirements in 130 CMR 630.437 apply to
HCBS
waiver providers in 130 CMR 630.404(D) who hire volunteers, contractors, or
employees to
provide HCBS waiver services to participants. Each HCBS waiver provider that
uses volunteers
or employs or independently contracts with hired personnel must
(1) check the candidate's references and job history and ensure that the
candidate meets all
of the required experience, education, and qualifications before hiring;
(2) conduct a Criminal Offender Records Information (CORI) check and determine
whether
any offender records may disqualify any personnel from direct contact with the
participant;
(3) ensure that each person who will have direct contact with participants has
satisfactorily
completed a prehiring physical examination and received a tuberculosis screening
within the
previous 12 months;
(4) ensure that all personnel who will have direct contact with participants
receive
tuberculosis screening every two years;
(5) ensure that all personnel are appropriately trained and managed;
(6) have available at all times a sufficient number of educated, experienced,
trained, and
competent personnel to provide services to persons with acquired brain injuries;
(7) evaluate personnel annually using standardized evaluation measures; and
(8) maintain a record of each performance evaluation in a separate personnel
file for each
person.
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Provider Manual Series
Subchapter Number and Title
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(130 CMR 630.000)
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(B) Personnel Training Requirements. Each HCBS waiver provider that uses
volunteers or
employs or independently contracts with hired personnel must
(1) provide initial and periodic training to all personnel who are responsible
for the care and
services to a participant. Records of completed training must be kept on file
and updated
regularly;
(2) hold an orientation for new personnel within one month of hire. This
orientation must
include the following topics for all personnel who will have direct contact with
participants:
(a) delivery of HCBS waiver services;
(b) written policies and procedures of the HCBS waiver provider;
(c) the requirements of 130 CMR 630.000;
(d) the roles and responsibilities of provider personnel;
(e) behavioral interventions, behavior acceptance, and accommodations;
(f) cardiopulmonary resuscitation (CPR) and first aid;
(g) infection control and safety practices;
(h) information about local health, fire, safety, and building codes;
(i) privacy and confidentiality;
(j) communication skills;
(k) abuse identification and reporting;
(l) good body mechanics;
(m) cultural sensitivity;
(n) universal precautions; and
(o) emergency procedures, including the provider’s fire, safety, and disaster
plans.
(C) Direct Service Delivery. Each individual who is responsible for delivery of
HCBS waiver
services to a participant must
(1) be a responsible person who is at least 18 years of age, with the ability to
make mature
and accurate judgments and with no mental, physical, or other impairments that
would
interfere with the adequate performance of the duties and responsibilities of an
HCBS waiver
provider;
(2) not abuse alcohol or drugs;
(3) be able to devote appropriate time necessary to provide needed services to
the
participant to ensure the participant’s safety and well-being at all times
during which the
service is delivered; and
(4) meet all other requirements established by the MRC.
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630.438: Withdrawal by an HCBS Waiver Provider from MassHealth
An HCBS waiver provider that intends to withdraw from MassHealth must satisfy
all of the
requirements set forth in 130 CMR 630.430.
(A) MassHealth Agency Notification.
(1) An ABI waiver provider electing to withdraw from participation in MassHealth
must give written notice of its intention to withdraw to the MassHealth agency.
The
HCBS waiver provider must send the withdrawal notice by certified or registered
mail
(return receipt requested) to the MassHealth agency. The notice must be received
by the
MassHealth agency no less than 90 days before the effective date of withdrawal.
(2) If such withdrawal results from a situation beyond the control of the HCBS
waiver
provider, such as fire or natural or unnatural disaster, the HCBS waiver
provider must
notify the MassHealth agency or its designee immediately by phone and follow up
in
writing within three calendar days. The burden of proof to demonstrate an
emergency is
the responsibility of the HCBS waiver provider.
(B) Notification to Participant and Family.
(1) The HCBS waiver provider must notify all participants, guardians, emergency
contacts, and other funding sources in writing of the intended closing date no
less than
90 days before the intended closing date and specify the assistance to be
provided to
each participant in identifying alternative services.
(2) On the same date on which the HCBS waiver provider sends a withdrawal notice
to
the MassHealth agency, the provider must give notice, in hand, to the
participants it
serves and their authorized representatives. The notice must advise any
participant that
on the effective date of the withdrawal, the participant must locate another
HCBS waiver
provider participating in MassHealth to ensure continuation of HCBS waiver
services.
(3) The notice must also state that the HCBS waiver provider will work promptly
and
diligently to arrange for the transfer of participants to other MassHealth-
participating
HCBS waiver providers or, if appropriate, to alternative community-service
providers.
(C) Coordination. The HCBS waiver provider must cooperate and coordinate with
the case
manager and assist in transferring participants to other programs.
Commonwealth of Massachusetts
MassHealth
Provider Manual Series
Subchapter Number and Title
4. Program Regulations
(130 CMR 630.000)
Page
4-34
Home- and Community-Based
Services Manual
Transmittal Letter
HCBS-1
Date
04/01/13
630.439: Recordkeeping Requirements
In addition to the recordkeeping requirements set forth in 130 CMR 450.205, all
HCBS
waiver providers must maintain a record for each participant receiving care and
services that
includes the following information:
(A) the member's name, member identification number, address, sex, age, and next
of kin;
(B) the care plan for the specific service being provided, including information
about
coordination with other services, as appropriate;
(C) complete documentation of all services provided and events that occurred
while providing
HCBS waiver services;
(D) for products and materials, a copy of the original invoice showing the cost
to the HCBS
waiver provider, copies of written warranties, and any discounts;
(E) for transportation, the originating location, destination, and mileage of
all trips; and
(F) other documentation as may be specified by EOHHS or MRC.
REGULATORY AUTHORITY
130 CMR 630.000: M.G.L. c. 118E, §§ 7 and 12.